Performing bimanual activities in everyday life : experiences of children with unilateral cerebral palsy

In everyday life, humans perform activities. Some activities demand the use of two hands and may be challenging to persons with reduced function in one hand. Alternative ways of performing such activities may then have to be used. However, when performing activities, humans also reveal who they are, as performance reflects individual preferences and values.

There are many alternative ways of performing a given activity, and in manual activities, one aspect that may vary is how the hands are used, what role each hand is allocated, and how mobility and grasp forces are applied. People with unilateral cerebral palsy (CP) have reduced hand function due to an early brain lesion. This affects the hand and arm on one side of the body, reducing the range of possibilities to use the affected hand. This thesis therefore describes how activities are performed in the presence of the diagnosis of unilateral CP and how such performance is viewed by the affected children and adolescents themselves. To describe the complexity of hand use and activity performance, the preceding matters were considered in relation to changes experienced after upper extremity surgery (UES) and in relation to other groups with reduced hand function due to different diagnoses. Due to the lack of questionnaires focusing on activities usually performed using both hands, part of the work of this thesis research was to develop a new questionnaire.

The results indicated that children and adolescents with unilateral CP experience problems related to bimanual activities. Finding a suitable performance alternative might pose a dilemma while it is necessary to consider aspects in the activity, within oneself and in the environment. Compared with children and adolescents with obstetric brachial plexus palsy (OBPP) or upper limb reduction deficiency (ULRD), those with unilateral CP seem to experience more problems and perform fewer bimanual activities independently. Adolescents treated with UES experience improvements in activity performance and in appearance. As these experienced improvement were mostly related to changes in everyday life, and did not directly correspond to aspects that are measured objectively, it is important also to assess qualitative aspects of activity performance and hand use in everyday life. The Children s Hand-use Experience Questionnaire (CHEQ) includes activities that are frequently performed independently with two hands by children aged 6 18 years with the diagnoses ULRD, OBPP, and unilateral CP. CHEQ also displays good signs of validity in terms of test content and internal structure.

List of scientific papers

I. Sköld A, Josephsson S, Eliasson AC. (2004). "Performing bimanual activities: the experiences of young persons with hemiplegic cerebral palsy" Am J Occup Ther 58: 416-425
https://pubmed.ncbi.nlm.nih.gov/15315248

II. Sköld A, Josephsson S, Fitinghoff H, Eliasson AC (2007). "Experiences of use of the cerebral palsy hemiplegic hand in young persons treated with upper extremity surgery." J Hand Ther 20: 262-272; quiz 273
https://pubmed.ncbi.nlm.nih.gov/17658420

III. Sköld, A., Norling-Hermansson, L., Krumlinde-Sundholm, L., Eliasson, AC (2010). "Development and evidence of validity for the Children s Hand-use Experience Questionnaire CHEQ." (Submitted)

IV. Sköld, A., Eliasson, AC., Norling (2010). "Bimanual Hand use in children with unilateral hand dysfunction differences related to diagnosis.Hermansson, L." (Manuscript)

V. Sköld A, Ekholm C, Eliasson AC (1999). "mproved hand function remains after upper-limb tendon transfer and muscle release in children with hemiplegia" Dev Med Child Neurol 41: 284-285
https://pubmed.ncbi.nlm.nih.gov/10355816